Provider Demographics
NPI:1316242753
Name:MARINACCIO, PHILIP A (OT)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:MARINACCIO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MAIN ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4946
Mailing Address - Country:US
Mailing Address - Phone:203-378-0092
Mailing Address - Fax:203-375-4540
Practice Address - Street 1:670 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2641
Practice Address - Country:US
Practice Address - Phone:203-783-1997
Practice Address - Fax:203-783-3997
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003616225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist